Provider Demographics
NPI:1710729165
Name:SUNG SAN ACUPUNCTURE LLC
Entity type:Organization
Organization Name:SUNG SAN ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUAH
Authorized Official - Middle Name:SUNGGON
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:L AC
Authorized Official - Phone:480-730-4991
Mailing Address - Street 1:1933 W MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-6930
Mailing Address - Country:US
Mailing Address - Phone:480-730-4991
Mailing Address - Fax:480-946-3366
Practice Address - Street 1:1933 W MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-6930
Practice Address - Country:US
Practice Address - Phone:480-730-4991
Practice Address - Fax:480-946-3366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty